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How much do alcoholics and drug addicts really have in common? Our experts explain the similarities as well as the differences.

Are Alkies Really Different than Addicts?

“When I first got sober, I remember going to AA meetings and identifying as an alcoholic and an addict,” explains Douglas, a 37-year-old property manager from Dallas who’s seven years sober but has the graying temples and sun spots of an older man. “But then my sponsor told me that if I was going to identify as both, I better put two dollars in the basket: one for each. I got the feeling that I had to choose between them—that I was either an alcoholic or an addict, but I couldn’t be both.”

Patty, another member of Alcoholics Anonymous, says, “There’s almost an unspoken taboo in AA where you’re not supposed to talk about drugs or refer to yourself as an alcoholic and addict.” With only two years of sobriety, Patty, who has blonde model looks and an easy smile, admits that she’s just as judgmental as the next person. “I can tell there’s a resistance because I think the same way,” she admits. “I snicker when someone identifies as an alcoholic and addict, but the fact is that everyone in that room is an addict—they’re just addicted to alcohol.”

Jan identifies solely as an alcoholic but she realizes that her addiction looks no different than the heroin user sitting next to her in a meeting.
And modern science agrees. As Dr. John Sharp, an addiction-focused psychiatrist who specializes in the integration of mood disorders and addictions, says, “Alcoholism is an addiction—it’s just one type of addiction. When you break out the specific things that someone who is suffering from alcoholism contends with—impaired control, preoccupation with a drug, using despite adverse consequences, distortions in thinking, most notably along the lines of denial—they are no different from any other type of addict.”

Sharp explains that the definition of addiction—a topic The Fix has covered at length—has been even further tweaked. “Recently, the American Society of Addiction Medicine came out with an updated definition of addiction, which identified five other aspects: inability to abstain consistently, impairment of behavioral control, cravings, diminished recognition of significant problems, and dysfunctional emotion responses. I think it’s fair to say you can apply those aspects to both drug users and alcoholics.”

Either way, when someone’s brain reacts in an addictive way to one substance, they will no doubt act that way to any substance, which is why so many struggle when they quit one drug only to pick up another. For many heroin addicts, alcohol is their way out of their primary addiction. For others, it might be marijuana. But at the end of the day, for many addicts/alcoholics, it all becomes the same. As Douglas, the Dallas alcoholic/addict, says, “I can be addicted to anything: women, booze, meth, cigarettes, food. The fact that I call myself an alcoholic is really just so that I can relate to other alcoholics. We’re all the same when we say that. I’m no more different or special than the drunk next to me, and chances are, we’ve both been addicted to drugs.”

Says Jan, a 45-year old school teacher from California who realized she was an alcoholic after years of coming to class drunk, “I always figured that there are different types of Anonymous organizations so we have the ability to connect to other people’s stories, but whether its gambling or sex or booze, addiction creates the same obsession of the mind and the inability to remove yourself from the addiction when you’re in it.”

According to addiction psychiatrist Dr. Reef Karim, she’s right. “There is no clinical term for addiction,” he says. “It is more of a pop culture term than a scientific one. The true definition is substance use disorder, which can be anything—meth, cocaine, alcohol. And then there are non-substance use disorders, which could be sex, gambling or porn. We define all of it as addiction. What’s the difference between alcohol and addiction? Words. Addiction describes the brain changes and behavioral changes that create consequences in your functioning.”

And for many alcoholics and addicts, these changes are the same. Jan identifies solely as an alcoholic but she realizes that her addiction looks no different than the heroin user sitting next to her in a meeting. “I think the reasons for having an addiction are the same,” she says. “We’re all trying to fill that same hole, that same void, with outside things. I do think that different addictions mean different effects on the brain chemistry and different chemicals affecting the body, but at the end of the day, we are both battling the same disease.”

Dr. Karim concurs, explaining how different drugs can affect the physiology of a substance user differently. “Each drug has its own specific challenges and battles,” he says. “When you’re looking at meth, there is a really strong neurotoxicity for the brain. Meth addicts not only have impairment but they can destroy neurons in the brain. With cocaine, there is more of a cardiovascular problem. One of the biggest troubles with alcohol is actually cultural. It is a social lubricant, and it is really big business. That’s why it’s everywhere. You can work an AA program, and do therapy, and get medication, but there are going to be triggers everywhere with alcohol. People go to bars all the time; they don’t go to crack houses.”

For Douglas, alcohol ultimately became the deadliest addiction. “There were times when I put down the hard drugs, and that’s when it really got scary,” he confesses. “Alcohol compromised me in ways that cocaine, and even meth, never could. It turned me into a different person—one who made decisions that the sane and sober Douglas never would. And I would think, ‘It’s only booze.’ But booze for an alcoholic is just as dangerous as crack.”

Dr. Sharp agrees. “Alcoholism shows up like all addictions do,” he says. “The only difference is that alcohol is more prevalent. It’s the most widely used drug in the world, and it’s a normal part of many cultures. But people who are vulnerable to addiction run into trouble with it in the same way they would run into trouble with substances that they might need to reach out for more, like illegal drugs which aren’t as widely available.”

For Patty, ultimately it didn’t matter whether she was battling booze, Vicodin, or an eating disorder. “Addiction is addiction,” she states. “I have bulimia and it’s been just as hard to recover from as it has been to recover from alcoholism, and recovering from pills is just as hard as recovering from drinking. It’s all fucking hard. Ultimately, as long as we think the drug or the behavior will make us feel better, it will always be difficult to find recovery or abstinence.”

“Both addicts and alcoholics have a disease that’s impacting their brain from a reward circuitry standpoint by telling them that drinking or using is a positive behavior,” says Kirim. “And there’s probably something else going on—like an anxiety or a spiritual problem. But then you also have the direct affect of the drug on the brain. So in one way, you’re dealing with one drug /alcohol disorder in terms of its causes but then you’re also dealing with two different disorders in terms of their consequences on the brain and the body.”

Douglas has seen the different effects of both, but believes it’s all one disease. “There are many alcoholics who become addicted to other substances, and there are a lot of people who are addicted to drugs and when they stop the drugs, they become to addicted to alcohol,” he says. “I almost wish that Bill Wilson had defined himself as an addict, too. I don’t think the disease is selective to the substance; some people just have a preference for the type of escape they like to have.”

Kristen McGuiness is a freelance writer and regular contributor to The Fix who wrote previously about the 13th step and dreaming about drinking, among other topics. She is the author of 51/50: The Magical Adventures of a Single Life.